Functional Evaluation of Oral Cavity and Oropharyngeal Reconstrucion Using Radial Forearm Free Flap

Eun, Seok Chan; Chung, Chul Hoon; Oh, Suk Joon; Burm, Jin Sik; Kim, Ju Bong

Abstract

The traditional focus of surgeon of all disciplines has been on curing patients. Unfortunately, this focus on cure has sometimes resulted in neglect of the functional outcomes and QOL that are experienced by patients. The treatment of oral cavity and oropharyngeal cancer can result in marked alteration in the functional status and general health. However, few studies have addressed themselves to measuring the speech, swallowing results, and the quality of life after definitive therapy. By use of sophisticated techniques, we can now document, quantify, and critically analyze the surgeon's reconstructive efforts. Using these methods, we have evaluated the radial forearm free flap in 26 patients receiving oral reconstruction between 1994 and 1999. The radial forearm fasciocutaneous free flap has proved extremely versatile in reconstructing defects of the orofacial region and has become a workhorse flap in head and neck reconstruction. It has advantages including small bulk, easy dissection, vascularity, and malleability. This study evaluated long term effects on performance statusin a cohort of patients successfully treated with a surgical approach. The results were compared by site and treatment modality. These patients age ranged from 33 to 75 years with a mean age of 52.6 years. The 10 patients in this series did not have preoperative radiotherapy, while sixteen other patients underwent full curative dosages of 6000-6300 Gy within six weeks of surgery. Sites of the lesions included the anterior two thirds of thw tongue, base of tongue, floor of mouth, and tonsil. The functional status were generally excellent. The speech, swallowing, aspiration, oral incompetence, VPI were examined in all pateints. The total score1 12.9 in mobile tongue cancer patients(hemiglossectomy), 7 in total glossectomy patients and 11.0 in tongue base, 12.5 in mouth floor, 9.5 in tonsilar cancer patients. Postopeative radiation therapy didn't affect the functional disability and the sensate flap can give more benefits for postoperative early rehabilitaition than non-sensate flap. Despite the devastating effects of ablative surgery, the application of avaliable reconstructive techniques can help to improve the quality of life of these patients. Our series serves to identify site-specific speech and swallowing problems to facilitate posttreatment rehabilitation of patients with oral cavity and oropharyngeal cancer.